Hemiarthroplasty For Unstable Intertrochanteric Fractures Research Articles

Comparison of three methods of greater trochanter fixation in intertrochanteric femur fractures (AO type 31/A2) treated with cementless bipolar hemiarthroplasty

Aim: The aim of this study was to compare the three most commonly used fixation methods for the fractured trochanter major fragment in patients undergoing uncemented bipolar hemiarthroplasty for unstable intertrochanteric fractures. Methods: The medical records of 231 acute hip fracture cases aged 65 years and older with AO classification 31/A2.2 and 31/A2.3 who underwent unilateral primary cementless bipolar hemiarthroplasty at Adana Şehir Training and Research Hospital between January 2021 and January 2023 were retrospectively analyzed. The files were classified into three groups based on the fixation technique used in the operation. Results: There were 231 files, with a mean age of 82.3±7.9. The majority (55.8%) were classified as ASA III. The analysis resulted in no significant differences between the groups in terms of age, number of days between the day of the injury and the day of the surgery, fixation failure, nonunion, number of revision surgeries, hospitalization duration, and HHS recorded at the third and sixth-month follow-up visits. Among the 73 males and 158 females, the ratio of the side in which the fracture occurred showed no difference (p=0.854). The female rate was significantly higher in group 3 compared to other groups (p=0.003). Regarding union success, cases in group 1 had significantly lower trochanter major union rates (p

Functional Outcomes of Primary Hemiarthroplasty for Unstable Intertrochanteric Fractures in the Elderly: A Prospective Observational Study.

Background and objective Intertrochanteric fractures pose a growing healthcare challenge among the elderly, demanding effective management strategies. This study addressed the rising incidence of hip fractures, emphasizing the complications associated with traditional nonsurgical approaches. It aimed to explore postoperative functional outcomes and complications associated withprimary hemiarthroplasty as an alternative to internal fixation for unstable intertrochanteric fractures in the elderly. Materials and methods This study included 20 elderly patients undergoing hemiarthroplasty for unstable intertrochanteric fractures. It evaluated key variables such as patient demographics, comorbidities, fracture characteristics, surgical approach, and postoperative metrics. To perform hemiarthroplasty, weutilized a nonmodular bipolar prosthesis with cement. Postoperative follow-up included an assessment of clinical and radiological parameters, focusing on outcomes and complications. Results The mean age of the participants was 71.65 years; it was found that a significant segment of the participants (n=9, 45%) did not have any comorbidities. The surgical outcomes were characterized by minimal blood loss (275 ± 57.35 ml), short hospital stays (6.55± 1.95 days), and satisfactory operative durations (80.25 ± 10.19 minutes). Additionally, 14 (70%) patients did not require blood transfusions. After the surgery, complications were minimal, and there were no cases of deep wound complications, prosthesis dislocations, or deep vein thrombosis. The Harris Hip Scores reflected favorable outcomes in 14 cases (72.7%), with good or excellent hip scores. Conclusions Our findings revealed that primary hemiarthroplasty is a reliable and effective strategy for managing unstable intertrochanteric fractures in the elderly, providing stable joints and acceptable complication rates. Early mobilization, facilitated by hemiarthroplasty, mitigates postoperative complications, making it a viable alternative for elderly patients.

Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70years: Boon or bane?

The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70years). Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12months. Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2days (1-8days). The average duration of surgery was 58 ± 6min (44-96min) with an average blood loss of 126 ± 24mL (90-380mL). HHS at the end of 12months was 77. The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.

Primary Hemiarthroplasty For Unstable Intertrochanteric Fractures In Octogenarian Patients With Multiple Medical Ailments

Primary Hemiarthroplasty For Unstable Intertrochanteric Fractures In Octogenarian Patients With Multiple Medical Ailments

Pre-fracture ambulation capacity, Charlson comorbidity index, and dementia as predictors of functional impairment after bipolar hemiarthroplasty for unstable intertrochanteric fracture. A retrospective analysis in 158 octogenarian patients

Background: the primary purpose of this study was to assess the ambulatory capacity 12 months after surgery in patients that underwent bipolar hemiarthroplasty (BH) due to unstable intertrochanteric fractures (UITF). Secondly, to identify which preoperative variables influenced these modifications. MethodsWe retrospectively analyzed a consecutive series of patients older than 80 years with UITF treated with BH between 2010 and 2019. Ambulatory capacity was assessed before surgery, at 3 and 12 months postoperatively, using Koval's classification and the modified Harris Hip Score (mHHS). The registered variables were: gender, age, osteoporosis, Charlson comorbidity index (CCI), ASA classification, body mass index (BMI), and dementia. The identification of variables that impaired postoperative functionality was performed by uni- and multivariate analysis. Results158 patients were included with a median age of 87 (range 80–102) years and a follow-up of 29.2 (range 12–56) months. The 1-year overall ambulatory capacity impairment was 28.5% and significantly affected pre-fracture community walkers (p = 0.001). A CCI >4 (OR 2.72; p = 0.044), dementia (OR 14.13; p = 0.0001), and a Koval 2–3 (OR 12.84; p = 0.001) were identified as risk factors for this impairment. ConclusionAmbulation impairment at one year was 28.5%. The predictive characteristics found in this study help to identify patients with a greater risk of ambulation impairment and to focus rehabilitation plans to reduce this impact.

Proximal femoral nail antirotation versus cemented calcar-replacement hemiarthroplasty for unstable intertrochanteric fracture in elderly: an overall survival study.

The aim of this study is to compare the perioperative complications and overall survival of patients who underwent proximal femoral nail antirotation (PFNA) and patients who underwent cemented calcar-replacement hemiarthroplasty (CCRH) for unstable intertrochanteric fracture in patients aged 75 years and older. A total of 94 patients who underwent PFNA or CCRH between 2010 and 2012 because of femur fracture (A2.2 and A2.3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification) were analyzed retrospectively. Hospitalization times, blood transfusion needs, reoperation rates, and overall survival were compared. Forty-eight patients in the PFNA group and 46 patients in the CCRH group were included for analysis. There was no statistically significant difference between the two groups in terms of hospitalization times, blood transfusion needs, reoperation rates, and survival rates. Both PFNA and CCRH techniques can be used for surgical treatment of unstable intertrochanteric femur fractures.

Hemiarthroplasty in Unstable Intertrochanteric Fractures in Elderly: A Prospective Study

Background: Grossly comminuted intertrochanteric fractures in osteoporotic bones are highly unstable and difficult totreat. Hemiarthroplasty is a popular choice because it provides stability and enables for immediate complete weightbearing.Objectives: The goal of this trial was to see how effective cemented hemiarthroplasty was at treating proximal femoralfractures in older people with severe osteoporosis.Methods: Thirty patients who had bipolar hemiarthroplasty for unstable intertrochanteric fractures were studiedprospectively. The posterior (Moore’s) technique was used to treat all of the patients with cemented bipolar prostheses.The average time of follow-up was 12 months. The modified Harris hip score was used to evaluate the patients.Results: Abductor weakness was present in 5 of the individuals. At the 12-month follow-up, 21 cases (70%) had badresults, while three cases (10%) had poor results. The average length of stay in the hospital was 10.9 days. Excellent to fairresults were observed in 24 patients, as measured by the modified Harris hip score.Conclusion: In older individuals with significant osteoporosis, the therapy of unstable intertrochanteric fractures differsfrom the treatment of other proximal femoral fractures. Internal fixation is not as effective as cemented hemiarthroplastyin treating these fractures. This approach has a clear advantage in terms of early full weight bearing and recovery. Hipsthat have undergone cemented hemiarthroplasty are stable and mobile. Weight bearing can begin earlier than with othertreatment approaches, avoiding any recumbency-related problems.

Comparative prospective study between cemented hemiarthroplasty and dynamic hip screw or proximal femur nail in elderly unstable intertrochanteric fracture

Introduction: Intertrochanteric femur (IT) fracture is a common fracture in old age. The cause of morbidity and mortality in IT femur is malunion, non-union, respiratory tract infections and bed sores, etc. DHS and PFN are time-tested treatment modalities but with availability of better implants and hemiarthroplasty techniques, mortality and morbidity can be reduced. Aims and objectives: To study and com- pare the advantages and disadvantages of hemiarthroplasty over dynamic hip screw and proximal femur nail for management of elderly unstable intertrochanteric fracture femur. Method and Materials: 120 patients of age 60 years and above, who were admit- ted and operated between October 2017 and March 2019 and had fulfilled the inclusion criteria, were enrolled for this study. Case selection was random. Bipolar Hemiarthroplasty: Total numbers of patients was 40, mean age 80.2 years, F: M ratio 14:26, follow-up period 1.1 years. DHS: Total numbers of patients was 40, mean age 70.1 years, F:M ratio 18:22, follow-up period 6 months. PFN: Total no of patients was 40, mean age 68.3 years, F:M ratio 11:29, follow-up period 6 months. Harris hip Scoring System assessed post operatively. Result: For result assessment and evaluation, we use Harris hip score, T-test, Chi- square test, and statistical analysis. P value< 0.05 is considered significant. Bipolar group: 1 had superficial wound infection, 1 had bed sore, and none had deep infection or pulmonary infection. Over all minimum post-operative complication and early mobilization seen. DHS group had maximum complication, PFN group had mixed results. Minimum blood loss seen with PFN and maximum with bipolar group. Excellent result observed at the end of 1 year: all patients who came for follow-up had good-to-excellent results. Conclusion: Functional recovery was delayed with internal fixation group. Early post-operative Harris hip score was better in patients treated with hemiarthroplasty as compared to internal fixation group but at the end of 1 year, score was comparable. Post-operative complications were more in internal fixation group than in hemiarthroplasty group and were comparable with other studies. Thus, in conclusion, primary hemiarthroplasty does provide a stable, pain-free, and mobile joint with acceptable complication rate as seen in our study; however a larger prospective randomised study comparing the use of dynamic hip screw and proximal femur nail against primary hemiarthroplasty for unstable intertrochanteric fracture is needed.

Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Unstable intertrochanteric fractures belonging to 31A2 and A3 varieties are difficult challenges for orthopaedic surgeons, particularly in the elderly patients. Osteosynthesis by dynamic hip screw or proximal femoral nail are often plagued by complications like screw cut-out, excessive collapse and fixation failures due to osteoporotic bones. Because of these complications, patients are often kept confined to the bed which may increase the risks of pressure sores, venous thrombosis and pulmonary infections. So, it is desirable to mobilize these elderly patients as quickly as possible following surgery. In recent decades, primary hemi-arthroplasty has emerged as a valuable treatment option for mobilizing these patients early.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We present our retrospective study on 27 patients above 60 years of age, who were managed with cemented bipolar hemi-arthroplasty after sustaining unstable intertrochanteric fractures. All the patients were operated through modified Hardinge approach. The fractured fragments were secured by stainless steel wiring, particularly the greater trochanter, wherever necessary.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Twenty-three patients (85%) were able to stand up with walkers by third post-operative day and were able to walk by fifth post-operative day. There was one case of hip dislocation; it was reduced under anaesthesia. No other complications were encountered at an average follow-up of 3.1 years. The Harris hip score was ‘good’ or ‘excellent’ in more than 60% patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Cemented hemi-arthroplasty appears to be a reliable treatment method for unstable intertrochanteric fractures in the elderly and it allows early weight-bearing and rehabilitation in most patients following surgery.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Primary Long Distal Fitting Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial. Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.

Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry.

The treatment of unstable intertrochanteric fracture in elderly patients is challenging and how to treat these patients remains controversial. The purposes of this study were to compare (1) reoperation rate, (2) mortality and (3) the postoperative change of walking ability between patients undergoing internal fixation (IF) and those undergoing bipolar hemiarthroplasty (HA) due to this type of fracture based on the data from the Korean Hip Fracture Registry. Between July 2014 and June 2016, we extracted 623 unstable intertrochanteric fractures (616 patients aged ≥ 65years) according to the classification of the Association for the Study of Internal Fixation-American Orthopaedic Trauma Association. Among the 564 patients, 396 were treated with IF (IF group) and 168 with bipolar HA (HA group). We compared the reoperation rate and mortality between IF group and HA group. In patients, who were followed up more than 2years after the surgery, we compared the postoperative change of walking activity from ambulatory outdoors (Koval's grade 1, 2, 3) to housebound (Koval's grade 4, 5, 6). The rate of reoperation was higher in the IF group (24/396, 6.1%) than in the HA (4/168, 2.4%) (p = 0.046). At the final follow-up, 79 (35.7%) of the 221 IF patients became housebound, whereas 21 (23.3%) of the 90 HA patients became housebound (p = 0.022). This study showed HA was associated with lower rate of reoperation and lower decrement rate of walking ability compared to IF in elderly patients with unstable intertrochanteric fractures.

Primary cemented hemiarthroplasty for unstable intertrochanteric fractures in elderly severe osteoporotic patients

ObjectiveTo evaluate the outcome of unstable intertrochanteric fractures with primary cemented hemiarthroplasty (HA) in elderly severe osteoporotic patients. Material and MethodsIn January 2009 to July 2017, 277 patients were selected according to inclusion criteria and results were analyzed prospectively. According to AO/OTA Classification, only type 31-A2.2(148 cases) and 31-A2.3(129cases) were included. 53 cases were males and 224 cases were females. The mean age was 75.4 years. The mean follow-up period was 50 months. The Harris Hip Score (HHS) and perioperative index (including the time duration of the surgery, intraoperative blood loss, postoperatively weight bearing time, implant complications) were analyzed clinically. ResultsFollow-up evaluations were performed at 6 weeks, 3, 6, 9 and 12 months, and every year thereafter (mean 50 months). The average duration of surgery was 43.2 min (range 21–65 min), with a mean blood loss of 225.8 ml (range 70–425 ml). All patients were out of the bed and mobile with help of walker with average of 3.3 days (range 1–5 days). The average duration of hospital stay was 12.3 days. Average HHS improved from 83.7 (range 63–90) at 6 months follow up to 90.3 (range 74–92) at final follow up. ConclusionFor the severe osteoporotic elderly with unstable fractures, bipolar hemiarthroplasty is an effective method to treat the unstable intertrochanteric fractures in the severe osteoporotic elderly. It can decrease complications, reduce mortality, improve the patient's life quality, and reduce family burden. In Summation, when deciding on treatment methods for intertrochanteric fractures several factors must be considered, which are (included but not limited to) the type of fracture, the patient's age, health status, severity of osteoporosis. As long as there was no absolute contraindication for surgery, it is appropriate to have surgery and to restore function as early as possible.

Primary bipolar hemiarthroplasty as a treatment option for unstable intertrochanteric fractures.

Management of unstable intertrochanteric fractures is challenging, especially in patients with osteoporosis. Comminuted unstable intertrochanteric fractures require postoperative immobilization. Several recent reports have recommended hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for unstable intertrochanteric fractures in older persons. Sixty patients aged over 75 years underwent hemiarthroplasty to treat unstable intertrochanteric fractures and were followed up over 12 months. All surgeries were performed by the same surgical team using the standard posterolateral approach. Wires, cables, and plates were used as required. Use of cemented protheses was considered when the lesser trochanter had been displaced. All patients were allowed full weight-bearing as tolerated. Clinical evaluation was based on Harris Hip Scores. The cohort comprised 16 men and 44 women (aged 75-96 years). According to the Jensen classification, 24 fractures were type III, 14 type IV, and 22 type V. Cement was used in 24 patients. At 12 months follow-up, Harris Hip Scores were excellent in 18%, good in 42%, fair in 25%, and poor in 15%. No radiological abnormalities were detected. Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures eliminates the need for prolonged immobilization and permits early ambulation. As reported by others, hip hemiarthroplasty is an effective treatment choice for unstable intertrochanteric femoral fracture in older patients.

Mid-term survivals of cemented calcar-replacement bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients

BackgroundThe literature has limited evidence regarding the mid-term survivals of cemented calcar-replacement bipolar hemiarthroplasty (HA) in elderly patients with unstable intertrochanteric (IT) fracture. The purpose of the present study was to evaluate clinical and radiological outcomes of cemented calcar-replacement bipolar HA for unstable IT fractures in elderly patients. MethodsOne hundred and twenty-two patients with the mean age of 80.6 years were enrolled in this retrospective study after they met the selection criteria. Demographics, main clinical characteristics, and operative data were recorded for all patients. Functional outcomes were assessed according to Koval's categories. Clinical and radiological evaluations were performed. Kaplan–Meier survival analysis was used to construct the cumulative survival rate. The mean follow-up time was 25.7 ± 2.9 months (ranges 0–72 months). ResultsBased on Koval's categories, 3 or 4-level decrease was detected in 21 patients (17%). Three patients (2 periprosthetic infections, 1 periprosthetic fracture) underwent reoperation during follow-up. No patient underwent revision of bipolar HA prosthesis. Femoral stem loosening and stem subsidence was the most common complication, observed in 22 patients (18%), followed by acetabular erosion that was seen in 12 patients (9.8%). The mean cumulative survival rate of prosthesis was 56.5% (95% confidence interval: 51.3–61.6). ConclusionBased on the results of our study, cemented calcar-replacement HA is an appropriate treatment option in elderly patients with unstable IT fractures owing to the advantages of satisfactory functional outcomes and lower reoperation rates. However, orthopedic surgeons should consider the low survival rates of cemented calcar-replacement HA prosthesis because of the increased femoral loosening in osteoporotic elderly patients.

Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: A prospective study

Aim of The Study: The aim of study is to analyse the functional outcomes of patients with comminuted intertrochanteric fracture treated by primary bipolar hemiarthroplasty and it’s complications. Methodology: Thirty patients (17 males and 13 females- all were 60 years old or above) who underwent bipolar hemiarthroplasty for unstable intertrochanteric fractures were prospectively evaluated. Results: In our study, mean age of the patient was 74.4 yrs,24 cases were of type 2 fractures, 4cases were type 3 fracture and 2 cases were type 4 fracture. 11patients had limb shortening of less than 2 cms, whereas 2 patient had limb shortening of more than 2cms.5 patients had abductor weakness. At 12 months follow up in 21 cases (70%), 3 cases (10%) had poor results. Conclusion: Our study, we concluded that bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients reduce the prolonged immoblisation, deformity, pain and provides better early ambulation and improved quality of life.

Outcome of primary cemented bipolar hemiarthroplasty in older patients with unstable hip fracture: A prospective study

Objective: Internal fixation as a classical method of treatment for unstable intertrochanteric fractures in older patients has significant complications and failure rate. This raises the need for a method that overcomes these difficulties and gives a better outcome. This study aims to evaluate the outcome of the use of primary cemented bipolar hemiarthroplasty in older patients with unstable intertrochanteric fracture both clinically and functionally. Methods: A prospective case series study conducted from January 2014 to February 2016 including 60 patients (>65-year-old) who were treated by primary cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures (Kyle 3 and 4). Main outcome measurements were clinical and mechanical complications, mortality rate, and functional outcome. Results: Early mobilization was good, that 93.3% of patients started partial weight-bearing on the 1st postoperative day. At the final follow-up (mean 13.66 ± 5.9 months), the general and mechanical complications were few; 1-year mortality rate was 16.7%; the mean Harris Hip score was 91.14 ± 5.7. Conclusions: Primary cemented bipolar hemiarthroplasty offers early, pain-free mobility with minimal complications and good functional outcome in older patients with unstable intertrochanteric fracture.

Mid-Term Survivals After Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

BackgroundTreatment of unstable intertrochanteric fracture in elderly patients remains challenging. The purpose of this prospective study is to determine clinical and radiological results of cementless bipolar hemiarthroplasty using a fully porous-coated stem in osteoporotic elderly patients with unstable intertrochanteric fractures with follow-up over 5 years. MethodsFrom January 2010 to December 2011, we performed 123 cementless bipolar hemiarthroplasties using fully porous-coated stem to treat unstable intertrochanteric fractures in elderly patients with osteoporosis. Clinical and radiographic evaluations were performed. ResultsFifty-three patients died and 14 patients were lost during the follow-up period. Mean follow-up period was 61.8 months postoperatively. Their mean Harris hip score was 77 points (range 36-100). None of these hips had loosening of the stem or osteolysis. Postoperative complications included nonunion of greater trochanter in 2 hips and dislocation in 2 hips. Two patients were reoperated due to periprosthetic fracture. One patient underwent implant revision due to periprosthetic infection. Thirty-one patients maintained walking activities similar to those before fracture. With follow-up period of 83 months, cumulative survival rates were 97.3% and 99.1% with reoperation for any reason and femoral stem revision as endpoint, respectively. ConclusionCementless bipolar hemiarthroplasty using a fully porous-coated stem is a useful surgical treatment option for unstable intertrochanteric fracture in elderly patients with osteoporosis.

What Are the Determinants of Mortality After Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients?

BackgroundPrimary hemiarthroplasty is proposed for the treatment of unstable intertrochanteric fractures in elderly patients with the advantages of early mobilization, acceptable functional results, and lower failure rates. The 1-year mortality rates demonstrated high variance in the literature, whereas, the factors related to 1-year mortality were not widely investigated. The main purpose of the present study was to determine predictive factors related to 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture. MethodsOne hundred six patients with the mean age of 80.7 years were included in this retrospective study. Age, gender, body mass index, comorbid diseases, American Society of Anesthesiologists score, total hospitalization time, time from injury to surgery, operation time, estimated blood loss, postoperative mobilization time, and decrease in Koval ambulatory categories were evaluated. Univariate and multivariate analyses were performed to determine major predictors of 1-year mortality. The Kaplan-Meier survival analysis was used to construct the cumulative survival rate. ResultsThree or more American Society of Anesthesiologists scores, presence of ≥3 comorbid diseases, and postoperative mobilization time of ≥2 days were significantly correlated with 1-year mortality. Presence of ≥3 comorbid systemic diseases was identified as the major predictive factor for 1-year mortality. The overall 5-year cumulative survival rate was 5.6%. ConclusionHaving three or more comorbid systemic diseases has been detected as the major determinant of 1-year mortality after primary cemented calcar-replacement bipolar hemiarthroplasty performed for unstable intertrochanteric fracture in elderly patients.

Arthroplastie intermédiaire de hanche pour fracture instable du massif trochantérien ou pour fracture cervicale déplacée. Étude cas témoin de deux cohortes de 80 cas

BackgroundWhile hemiarthroplasty (HA) is considered the treatment of choice for displaced femoral neck (FN) fractures in elderly patients, HA has been partly performed as an alternative treatment option for unstable intertrochanteric (IT) fractures. However, there is a paucity of data regarding the risk and availability of HA for unstable IT fractures compared to HA for displaced FN fractures in elderly patients. Therefore, we performed a case control study to determine: 1) whether HA for unstable IT fractures provides clinical results and survival comparable to HA for displaced FN fractures. HypothesisHA for unstable IT fractures in elderly patients provides clinical results and 1-year survival comparable to HA for displaced FN fractures in the same aging group. Materials and methodsWe identified 80 patients aged 75 years or older, who underwent cementless bipolar HA for unstable IT fracture (AO/OTA type 31-A2.2/3 and A3.3). Their clinical results and 1-year survival were compared to the matched control group of 80 patients with displaced FN fractures (Garden type 3 and 4) treated with the same procedure. Perioperative results, postoperative complications, and 1-year survival were investigated between the two groups. Functional outcome was assessed by walking status and Harris hip score (HHS) 6 months after surgery. ResultsOperating time was significantly longer in the IT group than the FN group (97.3min [50 to 255] vs. 79.3min [40 to 175], P=0.016). However, the two groups did not significantly differ regarding perioperative results such as total blood loss, transfusion, intraoperative fracture, length of hospital stay, and postoperative complication. No statistically significant differences in walking status and HHS were observed between the groups. No significant difference in cumulative survival was observed between the two groups (P=0.836), with a 1-year survival rate of 80% (95% confidence interval [CI], 71.8 to 87.5) in the IT group and 82% (95% CI, 73.1 to 89.4) in the FN group. ConclusionHA for unstable IT fractures in elderly patients showed clinical results and 1-year survival comparable to HA as the treatment of choice for displaced FN fractures in the same aging group. Level of evidenceLevel III, case-control study.

Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients; a comparison of 80 matched patients

BackgroundWhile hemiarthroplasty (HA) is considered the treatment of choice for displaced femoral neck (FN) fractures in elderly patients, HA has been partly performed as an alternative treatment option for unstable intertrochanteric (IT) fractures. However, there is a paucity of data regarding the risk and availability of HA for unstable IT fractures compared to HA for displaced FN fractures in elderly patients. Therefore, we performed this case-control study to determine whether HA for unstable IT fractures provides clinical results and survival comparable to HA for displaced FN fractures in elderly patients. HypothesisHA for unstable IT fractures in elderly patients provides clinical results and 1-year survival comparable to HA for displaced FN fractures in the same aging group. Materials and methodsWe identified 80 patients aged 75years or older, who underwent cementless bipolar HA for unstable IT fracture (AO/OTA type 31-A2.2/3 and A3.3). Their clinical results and 1-year survival were compared to the matched control group of 80 patients with displaced FN fractures (Garden type 3 and 4) treated with the same procedure. Perioperative results, postoperative complications, and 1-year survival were investigated between the two groups. Functional outcome was assessed by walking status and Harris hip score (HHS) 6months after surgery. ResultsOperating time was significantly longer in the IT group than the FN group (97.3min [50 to 255] vs. 79.3min [40 to 175], P=0.016). However, the two groups did not significantly differ regarding perioperative results, such as total blood loss, transfusion, intraoperative fracture, length of hospital stay, and postoperative complication. No statistically significant differences in walking status and HHS were observed between the groups. No significant difference in cumulative survival was observed between the two groups (P=0.836), with a 1-year survival rate of 80% (95% confidence interval [CI], 71.8 to 87.5) in the IT group and 82% (95% CI, 73.1 to 89.4) in the FN group. ConclusionHA for unstable IT fractures in elderly patients showed clinical results and 1-year survival comparable to HA as the treatment of choice for displaced FN fractures in the same aging group. Level of evidenceLevel III, case-control study.